Wegener's granulomatosis: Image findings in head and neck

Wegener's granulomatosis is a systemic necrotizing granulomatous vasculitis that in its earliest presentation frequently involves the head and neck. Offen it is not diagnosed at its initial stage so management of the disease is delayed. We believe in determining the common image findings of Wegener's granulomatosis will help in early diagnosis of this disease. In this study, we retrospectively review 17 cases of clinically and pathologically proved Wegener's granulomatosis seen in our hospital from Sep 1982 to Apr 1997. The clinical findings, plain films, CT scan and MRI were reviewed. Serum titers of c-ANCA were tested in 7 of the 17 patients. The results showed that the common clinical presentations were nasal obstruction, dyspnea, hearing impairment, visual impairment, proptosis, and hoarseness. All of the 7 cases tested with serum titers of c-ANCA showed positive results. The major findings of the plain films were obliteration of paranasal sinuses or mastoid air cells. The common CT findings were fluid collection in the paranasal sinuses, soft tissue thickening along the inner wall of paranasal sinuses or nasal chamber, subglottic stenosis with enhanced soft tissue mass, orbital mass lesion, sclerotic change of the wall of paranasal sinuses and fluid collection in the mastoid air cells. MRI findings in 2 patients detected the extension of the lesion more clearly. Subglottic stenosis with mass lesions were present in 7 of our 17 cases (41%) and the ratio was higher than in those previously reported in the literature. Mass lesions or infiltrations in orbital cavity were frequently associated with proptosis and disorders of the paranasal sinuses or the nasal chamber. The image findings which alerted us to initiated Wegener's granulomatosis into differential diagnosis included: unexplained subglottic stenosis; recurrent sinusitis or otitis refractory to management; mass lesion in orbital cavity with proptosis; destructive nasal mass lesion; and accompanying renal, pulmonary or other systemic lesions. Hypointense lesions on T2WI of MRI in the head and neck were also highly suggestive of Wegener's granulomatosis.